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LETTER TO EDITOR |
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Year : 1997 | Volume
: 45
| Issue : 4 | Page : 260 |
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Letter
S Saxena
Correspondence Address: S Saxena
Source of Support: None, Conflict of Interest: None | Check |
PMID: 9567027
How to cite this article: Saxena S. Letter. Indian J Ophthalmol 1997;45:260 |
Editor: | | |
I read with interest the article on risk factors influencing the treatment outcome in diabetic macular edema by Gupta et al.[1] In this retrospective study, advanced age, large size of clinically significant macular edema (CSME), and poor baseline visual acuity were found to be associated with poorer outcome. Diabetic macular edema (DME) was defined as CSME by Early Treatment Diabetic Retinopathy Study (ETDRS).[2] Each of the defined characteristics include retinal thickening, the hall mark of DME. Retinal thickening cannot be seen in non-stereo photographs. CSME is assessed by contact lens or non-contact lens biomicroscopy and stereo photography. A magnified stereo examination of the macula is necessary to detect retinal thickening.[2] Thus, assessment of the size, extent and location of CSME, in this study remains unclear. Assessment of CSME from fundus drawings is also questionable.
Recent ETDRS report number 19 reported whether the efficacy of focal photocoagulation treatment of DME may be influenced by degree of capillary closure, severity or source of fluorescein leakage, extent of retinal edema, presence of cystoid changes or severity of hard exudates.[3] Grading of baseline stereoscopic fluorescein angiograms and colour fundus photographs was done. The extent of thickening within 1,500 μm of the centre of the macula and the degree of thickening at the centre were found to correlate well. Treatment effect increased as the extent of retinal thickening increased. The analyses by degree of thickening at the centre of macula showed that treatment effect increased from zero when thickening was questionable to about 50% when retinal thickness at the centre was estimated to equal or exceed the "reference thickness" (maximum thickness of the normal retina at a distance of 750 to 1,500 μm from the centre). Argon and krypton laser used for the treatment did not significantly influence,the outcome in this study.
References | | |
1. | Gupta A, Gupta V, Dogra MR, Pandav SS. Risk factors influencing the treatment outcome in diabetic macular edema. Indian J Ophthalmol 1996;44;145-48. |
2. | Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. ETDRS report number 1. Arch Ophthalmol 1985;103:1796-806. |
3. | Early Treatment Diabetic Retinopathy Study Research Group. Focal photocoagulation treatment of diabetic macular edema: relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline. ETDRS report number 19. Arch Ophthalmol 1995;113:1144-55. |
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